Grave's Disease and Primary Biliary Cirrhosis—An Unusual and Challenging Association

Shetty, Shiran; Rajasekaran, Senthilkumar; Venkatakrishnan, L

doi:10.1016/j.jceh.2013.08.001

Cited by 10 publications

(10 citation statements)

References 6 publications

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“…Two cases suffered from concomitant autoimmune diseases. It has been reported that the onset of hyperthyroidism can cause liver abnormalities in PBC patients [6,13]. However, the onset of hyperthyroidism itself did not seem to have any impact on the severity or clinical course of PBC in other case reports, as far as appropriate treatment.…”

Section: Discussionmentioning

confidence: 77%

Primary biliary cirrhosis associated with Graves’ disease in a male patient

Suzuki

Ishida

Takahashi

et al. 2016

Clin J Gastroenterol

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Primary biliary cirrhosis (PBC), which predominantly affects women, has been associated with various autoimmune diseases. Although hypothyroidism accompanying PBC is well documented, the concomitance of PBC and hyperthyroidism is rare. Herein, we report the case of a 62-year-old man who was diagnosed with PBC several years after the development of Graves' disease. This is the first case of a male patient developing PBC with Graves' disease. Both serum alanine aminotransferase levels and serum thyroid hormone levels were normalized after the administration of thiamazole for Graves' disease. However, the cholestatic liver enzyme abnormalities continued, indicating that the PBC was actualized by the administration of thiamazole. After starting ursodeoxycholic acid treatment, cholestatic liver enzyme abnormalities improved. Taken together, when a cholestatic pattern of liver enzymes is observed during follow-up for Graves' disease, an association between Graves' disease and PBC should be considered as a differential diagnosis.

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Section: Discussionmentioning

confidence: 77%

Primary biliary cirrhosis associated with Graves’ disease in a male patient

Suzuki

Ishida

Takahashi

et al. 2016

Clin J Gastroenterol

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“…Hepatitis C viral infection was associated with thyroid abnormalities [11]. The prevalence of autoimmune thyroid disease is increased in cases of chronic hepatitis associated with primary biliary cirrhosis (PBC) or chronic autoimmune hepatitis [12,13].…”

Section: Introductionmentioning

confidence: 99%

Influence of Thyroid Stimulating Hormone on Liver Enzymes Levels in Serum of Thyroid Disorder Iraqi Patients

Samir¹,

Hameed²

2019

ANJS

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Thyroid hormones are essential element in body growth and influence the formation of many enzymatic proteins. These hormones regulate and have a major role in controlling the metabolism of the entire body. They also play an important role in the normal hepatic function. Thyroid diseases are linked with liver enzymes levels irregularities, cholestatic jaundice resulted from low bilirubin level and bile excretion, hepatic lipid homeostasis, viral hepatitis, an increase in alanine aminotransferase, aspartate transferase and alkaline phosphatase. Thyroid stimulating hormone and serum liver enzymes were analyzed using standard kits. Results showed that hyperthyroidism and hypothyroidism patients had an elevation in the levels of serum alkaline phosphatase, aspartate transferase and alanine aminotransferase when compared to controls. However, the values were higher in hyperthyroidism patients. This work aims to study the effect of thyroid stimulating hormone on the level of liver enzymes in a group of local Iraqi patients with thyroid disorder.

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“…Заболевания печени у больных гипертиреозом могут выступать в трех ипостасях: лекарственные гепатиты, развивающиеся в ответ на прием тиреостатиков, сопутствующие аутоиммунные заболевания печени и, наконец, гепатопатии как непосредственное проявление тиреотоксикоза [4][5][6]. Гепатотоксичность тиреостатиков проявляется менее чем в 0,5% случаев [4] Патология печени при гипертиреозе в большинстве случаев ограничивается бессимптомным изменением лабораторных показателей и гораздо реже приобретает клиническое воплощение.…”

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“…объясняет случаи сочетания болезни Грейвса с аутоиммунным гепатитом [4,5,8] и первичным билиарным циррозом [6].…”

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“…[4] из 8 описанных случаев 2 было представлено аутоиммунным гепатитом, еще 3лекарственным гепатитом, индуцированным пропилтиоурацилом, и лишь оставшиеся 3 случаясобственно отражением тиреотоксикоза. Механизм развития тиреотоксического гепатита объясняется диспропорцией между кровоснабжением и метаболическими затратами печени, развивающейся в условиях повышенного сердечного выброса [6,9]. Правожелудочковая сердечная недостаточность, вызванная тиреогенной миокардиодистрофией, может усугубить повреждение печени [4,9].…”

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Thyrotoxic hepatitis

Pikulev¹,

Клеменов²

2017

Probl Endokrinol (Mosk)

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In most cases, liver pathology in hyperthyroidism is confined to asymptomatic changes in laboratory indices, while clinical signs are much rarer. Three clinical variants of liver pathology in patients with hyperthyroidism can be differentiated: drug-induced hepatitis that develop in response to administration of thyrostatic agents (mainly propylthiouracil); concomitant autoimmune liver diseases (autoimmune hepatitis, primary biliary cirrhosis), and hepatopathies as a direct manifestation of thyrotoxicosis (thyrotoxic hepatitis). Thyrotoxic hepatitis is a rare condition difficult to diagnose. The variety of etiological factor of liver pathology in hyperthyroidism, universal clinical symptoms, and the lack of specific histological markers make it difficult to make a correct diagnosis. A clinical case of Graves’ disease complicated with severe thyrotoxic hepatitis, the edema-ascites syndrome and hyperbilirubinemia is reported. The patient was diagnosed with thyrotoxic hepatitis after all other reasons for liver pathology have been ruled out. The concomitant thyrogenic myocardiodystrophy, cardiomegaly and atrial fibrillation required ruling out the diagnosis of cardiogenic liver injury and made diagnosing more difficult. Normalization of the thyroid status in patients receiving mercazolyl therapy was accompanied by alleviation of clinical symptoms of hepatitis and the positive dynamics of the indices of liver function tests. A brief review of the data on clinical variants and mechanisms of liver injury in patients with thyrotoxicosis is presented.

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Grave's Disease and Primary Biliary Cirrhosis—An Unusual and Challenging Association

Cited by 10 publications

References 6 publications

Primary biliary cirrhosis associated with Graves’ disease in a male patient

Primary biliary cirrhosis associated with Graves’ disease in a male patient

Influence of Thyroid Stimulating Hormone on Liver Enzymes Levels in Serum of Thyroid Disorder Iraqi Patients

Thyrotoxic hepatitis

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